Delirium is a common condition in older patients presenting to the ED, present in up to 20% of geriatric patients, and is associated with adverse clinical, cognitive and functional outcomes. Identification and documentation of delirium is associated with improved outcomes, yet delirium goes unrecognized and undocumented in the ED up to 80% of the time. The ED offers a unique setting to rapidly identify and begin managing delirious patients at the point of entry to the hospital, but the efficacy of systematic screening combined with guidelines for initial management in the ED has not been examined. We will refine and pilot test an intervention, Delirium Screening (D-SCREEN), involving 300 older patients (150 newly enrolled intervention participants, 150 historical controls (comparison group) currently being collected), that has 4 key components: 1. Systematic screening for delirium using the CAM, 2. Informing providers of the screening result, 3. Providing a checklist protocol for initial delirium management based on clinical guidelines, and 4. Documentation of the diagnosis of delirium in the Electronic Medical Record (EMR) and communication with inpatient providers. The specific aims of the proposed project are to: 1. Refine and test the feasibility and acceptability of the D- SCREEN intervention using quantitative data from medical record review of intervention adherence and qualitative data collected through focus group interviews with ED providers (M.D.s and R.N.s) pre-and post intervention, and 2. Examine the impact of D-SCREEN on documentation of delirium in the 150 newly enrolled intervention group compared with 150 already collected historical controls. Our findings will provide state-of- the-art evaluation of an innovative yet pragmatic 4-step screening intervention for delirium in the ED that includes a checklist protocol for initial delirium management at point of hospital entry.